Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. VI. Of a FRACTƲRE with a WOƲND, the Bone not bare.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and in Latin, Fractura cum Vulnere, Osse non nudato; and in English, à Fracture with a Wound, the Bone not being made bare. viz. not made bare of the Periosteon.

II. Now it may be in a Fracture with a Wound, that no Bone, or part of a Bone, as splinters or bits of Bones may be made bare of the Periosteum; yet we may have great cause to fear, that some broken Bone may apostemate, and be expelled, or come forth; which is done, when in process of time they grow dry and withered, so that they cannot be agglutinated again to the whole or sound Bone: or in a Fracture, when they are so separated from the rest of the Bone, that they cannot be joined with it any more.

III. For Nature endeavours to expel whatever is troublesom to her, and what cannot be united again; nor will she be at rest, 'till whatever is offensive, is wholly cast forth; tho' some∣times it is a long time first.

IV. The Causes. They are either when pieces of Bones are so sepa∣rated, that they cannot be put together again, then an Apostem is generated; or from corrupt Sa∣nies, which fouls the Bones; or when they are altered by the ambient Air.

V. The Signs. Hippocrates, de Fract. lib. 3. text. 18. gives us the Signs of a Bone in danger of Apostemating, and so to be ex∣pelled: 1. There flows forth a much greater quantity of Sa∣nies, than could reasonably be expected, either from the ma∣gnitude, or the nature of the Wound.

VI. 2. The lips of the Wound do not meet together; or if they do so; yet they soon are separated; and the Wound putrifies, and is provoked and stirred up to Excre∣tion; the lips becoming loose and spongy, and in the wounded Part, there is a kind of soft motion.

VII. 3. If you perceive the Bone bare of Flesh, it is a sign of its separation, and dropping forth; for that it may be altered or corrupted by the Air, nor can any longer receive Nutriment from the Veins and Arteries, which used to convey the same.

VIII. 4. If you manifestly per∣ceive the Bone is broken into many shivers or bits, it is impossi∣ble for them to be reposited again; and if not, as they cannot be conglutinated, so they must apostemate, and be expelled; for Nature never heals a Wound, so long as any thing remains within that cannot be assimula∣ted, or agglutinated with the rest.

IX. The Prognosticks. It is a sign of a recession suddenly to follow, if good Flesh breed in the sides of the sound Bone; and also when there is a quick digestion or suppuration in the Wound.

X. But the time in which the Bones are wont to recede and fall forth, is various: for if it is in Youth, and in the Summer∣time, and the Bone not very great, it may be expelled or thrust forth in 20, or 30, or 40 days.

XI. But if it is in one of full and ripe Age, and in Winter-time, and the Bone is of the larger kind, it Apostemates not so soon; and it is many times 60 days, before it is separated and thrust forth.

XII. The Cure. If the displaced piece of Bone sticks in the very Wound, it is presently to be taken forth with the Volsella or Pliers, or Pincers, if it can be done with∣out pain and violence: but other∣wise, the whole Work is to be committed to Nature: for if Violence be used, Pain, Inflam∣mation, Fever, and Convulsions may possibly be excited, and a fistulous Ulcer may be induced.

XIII. You ought also to consider the piece of Bone which is to come away, if it is great, or little; which you may know by the intensness or remisness of the aforegoing Signs: for if Digestion or Suppuration comes slowly on, and much Sa∣nies appears, and much loose and spungy Flesh is bred, a great piece will be expelled; & è contra.

XIV. Now Nature is to be helpt by Art, and Medicaments are to be laid upon the Wound; which have in them a power of Attraction, to draw out of the Wound the broken pieces of Bones, and whatever is extraneous to the same.

XV. If the part of Bone to be extracted is small, you must be sure that the generated Pus, may not stay too long in the Wound, lest it corrupt the sound Bone; but that it may have liberty to be eva∣cuated, (not by pressure of strait Bandage, lest Pain and In∣flammation be excited, but rather) of its own accord.

XVI. Then the recession of the Bone is to be committed to Nature: and you must use loose Bandage, and frequent openings of it, that the Pus may not stop, but freely pass forth: Splints, or Ferulae, are to be avoided, lest they cause pain, by their compression; and such things are to be applied, as may soonest perfect the Digestion or Suppuration.

XVII. The Wound also, if it is large, is to he stitched, notwith∣standing the recess of the Bone; for Nature will never heal up the Wound, till the pieces of the Bone are come forth; then the Dige∣stive being applied, as you may see occasion, the Fracture is to be bound up loosly, but with many Rowlers, as we have al∣ready shewn.

XVIII. If the Fragment of the Bone to be extracted is very great, you must, as before, be very care∣ful not to retain the Pus, but that it may run freely forth, and the wounded Part is to be handled with all the gentleness imagina∣ble, as Hippoerates, de Fract. lib. 2. Text. 44. advises.

XIX. For the Fragments of the Bone, not being replaced as they ought to be, if they be much com∣pressed, they will prick the Parts lying near to them, which are very sensible of pain; for which reason, those strait bindings which are necessary in other Fractures, would here do mischief.

XX. Now Hippocrates, Text. 21. of the place afore-cited, makes no use of the Swathe or Rowler, lest the Parts should be prest to∣gether too much; or being for∣ced to lift it up, should excite pain.

XXI. But having replaced the Bones as well as may be, he applies unto the Wound Ceratum Piceum, Ceratum Rosaceum, or some other like Cerate, fit for green Wounds; for that these things help for∣wards the Digestion or Suppu∣ration, and prevent Inflamma∣tion.

XXII. If there is much Pain, and danger of Convulsions, he then applies Linnen-cloths dipt in Oil and Wine mixt together.

XXIII. This done, because of the weakness of the Part, and the imminent danger of a Fluxion of Humors, he uses many Splenia or Plagulae, made of double Lin∣nen-cloth about two Inches or more broad, and so long as to go once and almost half about the wounded Member.

XXIV. For if they should be shorter, they would not keep the Fracture stable; and if they should be longer, they would not be con∣venient; because when the Part is unbound to renew the Appli∣cations, it must be lifted up and moved; but they ought to be of such a length, that with∣out stirring the Limb, both the heads may be so loosned, that the Wound may fully appear.

XXV. These Plagulae (so ma∣ny as are necessary) are to be dipt into black or red austere Wine, to make them stick the better, pre∣vent Inflammation, and preserve the substance of the Part sound; (and Galen keeps them so wet, Night and Day, or else Sponge; dipt in such Wine.)

XXVI. They are to be so many that no space may be left empty; and they are so to be applied to the Member, that their heads may be drawn by the place affected, not round and circularly, but a little sloping, so as that from the con∣trary part where they begun, they may be brought together the one to the other, and cross one another, after the manner of the Letter X, by drawing the right head to the left part, and

the left head, to the right Part.

XXVII. These Splenia, for that they are not very long, and may be so opened that the Wound may appear, without lifting up or moving the Limb, are very con∣venient.

XXVIII. There may also be apply'd a binding up, which may be compleated with once rowling about, and which may be done with a Swath or Rowler folded together with a twice or thrice folded Linnen Cloth, after the manner of a Cross-cloth, but so artificially sew'd together in the sides, and so broad, that it may cover the whole Wound.

XXIX. These things perform'd, the Member is to be laid easily in some proper Capsula, or other like thing, to keep the Fractured Parts in their proper place.

XXX. When the danger of the Inflammation is over, you must ap∣ply things proper for to remove the Receeding Bone, in which work, Nature is to be assisted by Art; for this purpose, Oil Olive mix'd with Bees Wax, adding thereto of Euphorbium, j. part: of Comfrey ij. parts: and of round Birth∣wort iij. parts: Avicen com∣mends it, to be used in strong full grown Bodies, and in Win∣ter time: but he used Spurge, instead of Comfrey, which we have put in, instead thereof.

XXXI. Others commend for the Extraction of Bones, Ammo∣niacum and Bedellium, dis∣olved in Oil of Lillies: so also pouder of Earth-worms (some say their Ashes) mixt with Ho∣ney: which brings them forth by a specifick property.